Malignant Barrett's oesophagus.

Barrett's oesophagus is a pre-malignant condition with an increased risk of adenocarcinoma. The prevalence of adenocarcinoma in Barrett's oesophagus is about 10% but its true incidence in the general population is unknown. The development of adenocarcinoma in Barrett's oesophagus is a multi-step process. Gastro-oesophageal reflux symptoms are absent in many Barrett's patients and both Barrett's oesophagus and adenocarcinoma are usually but not always diagnosed simultaneously. When a carcinoma is identified, the treatment of choice is resection. Three-stage oesophagectomy is considered the most appropriate procedure. The prognosis of Barrett's carcinoma is dismal and the survival rate is related to stage of the tumour. However, encouraging results have been reported in the past 5 years. Endoscopic surveillance for Barrett's oesophagus is still a controversial topic but for some high-risk subgroups of patients regular surveillance is advocated. At the present time, dysplasia is the best available indicator of malignancy in Barrett's oesophagus.